From the editor

This issue of Field Exchange comes out in the wake of the Haiti emergency. Although the relief effort is continuing, the acute phase of the emergency is arguably over at the time of writing, with humanitarian efforts now focused on rebuilding infrastructure - especially provision of shelter and homes. In following, and participating in (see next Field Exchange issue 39) the unfolding events, the ENN became acutely aware of the media coverage of the emergency and not for the first time found it exasperating.

Pastoralist women discussing seasonal
and annual variations in the dietary
intake of their children

"The worst emergency the world has ever faced", "chaotic relief distributions with no-one knowing who is in charge", "seven days since the quake struck and people still haven't received water, food or health care". These quotes signify the main thrust of global media coverage of the Haiti earthquake disaster and of the international community's response. Although there has been no rigorous analysis yet, the overwhelming majority of written, TV, internet and radio coverage of the emergency chose to highlight equally the appalling circumstances of the 'quake's victims and the "failure of the international humanitarian system to do anything about this".

While this type of media coverage may be appropriate in one sense, i.e. to help mobilise political commitment at government and civil society level, it was also by turns grossly inaccurate and heavily skewed towards sensationalism. Key facts and contextual factors which largely explain how the international response unfolded were omitted or relegated to 'throw-away' paragraphs. Critical information which were not highlighted includes the fact that Haiti is one of the poorest countries in the Western hemisphere with the least capacity to host and support an international humanitarian response - particularly in the area of security. To add to this, up to 200 UN workers, including the Humanitarian Coordinator, were killed by the 'quake making it virtually impossible for the UN to hit the ground running. There was little acknowledgement in coverage that the international organisational response embedded in the recent humanitarian reform process and involving 12 sectoral clusters worked relatively well, with excellent sectoral coordination being achieved within the nutrition sector in a few days. There was little mention either that the humanitarian workers on the ground worked inhuman hours often with nowhere to sleep and no washing facilities and as a result were burning out in a matter of days resulting in high levels of staff turn-over. The scale and speed of crisis meant that if this disaster had happened in the US or another rich Western country (remember Hurricane Katrina) there would still have been enormous challenges in mounting a response.

Whether, as claimed and widely reported, this was the worst emergency the world has ever faced depends on how you measure the degree of an emergency. Key indicators of mortality, morbidity and malnutrition that are normally used to measure a crisis suggest that Haiti will be remembered as a moderate emergency only. If the extent of the emergency is measured in terms of the speed of response, then again Haiti fared moderately well compared to numerous less publicised 'silent' emergencies over the past 30 years. Such claims therefore reflect lack of institutional memory amongst the media, their need to create sensational news and a considerable lack of rigour within the media profession.

The question has to be asked whether this type of media hype matters, if the end product is greater urgency of response. Well frankly it matters a great deal. Never mind the fact that the truth is being distorted while feeding into the fears and biases of the watching world, such coverage undermines the credibility of the international humanitarian system and may well have implications for short and medium term funding. Furthermore, in the early days of a response when information is often lacking, the humanitarian agencies themselves may be looking to the press reports emerging to guide their response - some information is better than no information. Or is it? On a more human level, it also undermines the morale of the systems foot-soldiers. Implied criticisms of the men and women who often risk life and limb - not to mention emotional health, working in the kind of physical environment that very few of us could endure, is akin to publically criticising an army in the middle of battle. The parallels are obvious except that the international community is not waging a war here, but trying to save as many lives as possible.

So why does the media succumb to this type of half-truth sensationalist coverage of humanitarian crises? There may be several reasons. Gone are the days when the media had resident 'stringers' in country with intimate knowledge of context. Now, journalists (many of whom are very young) are 'parachuted' in with no knowledge of the country and limited knowledge of the humanitarian system. At the same time, they are acutely aware of the need to come up with a story that somehow surpasses the horror of previous emergencies. There also appears to be an anti-'good news' culture in the media. Reporting on a system working well within the confines of what is possible is not newsworthy.

There are, of course, exceptions in the media. A number of experienced journalists who have witnessed past emergencies and have a realistic understanding of the humanitarian response process provide more balance and broader perspective. It is also noticeable that as the emergency unfolded, coverage gradually became more balanced. This almost certainly reflects the steep learning curve of journalists as they witnessed what the system achieved against often impossible odds. There is always the hope therefore that some of these journalists will maintain an interest in humanitarian crises and response and be better informed in future coverage. However, the overwhelming balance of media coverage remains sensationalist and devoid of meaningful analysis.

Questions therefore have to be asked about accountability of the media with respect to providing the public with real and balanced information. Why is it that the humanitarian system is rightly held to account in terms of performance (although there are weaknesses here as well) whereas the media isn't? The humanitarian system does not have the resources or the appetite to challenge what is written or presented about it in the 24 hour global media. It is too busy saving lives. The rewards for those who work in the system are often charges of failure and incompetence and sometimes worse - neglect. Nothing could be further from the truth. Isn't it time we examined closely how the media covers this type of emergency with a view to strengthening its professionalism and holding those who work as journalists, to greater account?

Speaking of hidden emergencies, this issue features two articles that share experiences around the humanitarian response on infant and young child feeding (IYCF) during the 2008/09 Israeli bombardment of the Gaza strip. One article describes the experiences of a local organisation, Near East Council of Churches Committee for Refugee Work (NECCCRW) that has been working in the area for 42 years, and is supported by Dan ChurchAid. The second relates the experiences of the Save the Children responses to the acute crisis through their established local partners. Both articles reflect the strong commitment and concern of each organisation to meet the nutrition needs of infants and young children. They also serve to highlight some of the challenges of operating in such a complex and chronically debilitated environment. Key questions around policy guidance and the challenges and reality of implementation are inevitably raised.

The NECCCRW article describes how their intervention was built upon an established clinic programme of nutritional counselling, micronutrient supplementation and follow-up. The new project involved comprehensive household screening and diagnosis/referral of malnutrition and anaemia, development of a new database to enhance the management of patient data and follow up, and supplementary feeding through the supply of infant formula to malnourished children. The article from Save the Children describes a detailed assessment of infant and young child feeding practices, fuelled by concerns around the widespread distribution of breastmilk substitutes (BMS) during the acute emergency response, complementary feeding needs, and chronic undernutrition in the population compounded by poor pre-crisis feeding practices.

Save the Children's assessment found poor feeding practices such as low exclusive and continued breastfeeding rates, which were pretty typical of the situation pre-conflict. Many mothers reported reducing or in some cases, stopping breastfeeding during the conflict but not due to BMS availability (one-third of assessed mothers had received infant formula in distributions). Rather feeding problems, stress and lack of food were their reasons. Diarrhoea prevalence was high (38% when corrected for season) but no associated cause was identified. The authors suggest that the distribution of BMS probably reinforced poor feeding practices. In addition, the humanitarian effort failed to recognise or act on other essential components of mounting an infant and young child feeding in emergencies (IFE) response - for example, breastfeeding counselling and support in a traumatic situation and food for mothers. Lack of awareness of key policy guidance - the International Code, Sphere standards, the Operational Guidance on IFE - by national and international players were identified as part of the problem. However, the authors also allude to the challenges of implementing policy guidance in a context of pre-existing high BMS use and low exclusive breastfeeding; this is a critical point.

A scene from the Gaza Strip

The supplementary feeding programme that NECCCRW operated was, in many respects, atypical. Children were admitted under weight for age and height for age (stunting) criteria as well as weight for height. This complicated interpretation of exit indicators and lengths of stay in relation to Sphere standards. Most controversial was the use of infant formula targeted at malnourished children aged 6m-3 years of age. At face value, this contravenes policy guidance that seeks to protect and support breastfeeding, and not mix formula feeding and breastfeeding. But what do you do in an emergency- affected population where this is the prevalent practice? Any review of NECCCRWs programming has to be interpreted from the perspective that we honestly don't know how to respond programmatically in this type of situation. It is also important to take into account the fact that infant formula was provided in a monitored programme, attached to a clinic, with a community household visit programme and with committed care and follow-up. Such a programme should not be 'tarred with the same brush' as distribution of infant formula from the back of a truck. There are still issues to consider, for example, was infant formula use really warranted or could it have been used to fortify foods rather than distributed as a drink? - but understanding the origin, rationale and context of this programme is critical to determining realistic expectations around programme design.

These experiences raise the question, can we expect to achieve optimal standards of care in every emergency from the word 'go' or is compromise necessary in the immediate term and if so, how can this 'middle ground' be negotiated and managed? A related question is how can policy guidance respond to national contexts? The International Code of Marketing of BMS doesn't ban the use of infant formula but seeks to ensure fair play; it protects against inappropriate marketing while supporting stipulation that it is used for infants that need it and that packages are in appropriate language, etc. The Code should be enacted into national legislation and is a key emergency preparedness action; this allows the context to be reflected in legislative law and carries the weight of national law with it as a result. The Operational Guidance on IFE, currently reflected in the updated version of SPHERE, was produced through an interagency collaboration to address field challenges during IFE response. Again, this guidance doesn't ban infant formula use; if infants are artificially fed, then action is needed to minimise the risks. So there is room for pragmatism in the guidance; but considered and informed coordination is needed to enable this. Lack of clear leadership on IFE in Gaza was highlighted by Save the Children as a limiting factor. Experiences from many past and current emergencies show how critical leadership is to ensuring optimal IFE programming.

What is obvious from both articles is that context is everything. Standalone guidance does not work. Provisions need to be integrated into national policy guidance. NECCCRW's programming was informed by national guidance and policy; this is the policy framework that needs to be strengthened. International agencies must work with national governments and long term local partners - like NECCCRW - to review and develop policy guidance and perhaps most critically, to identify constraints to implementation and how best to overcome these. These types of considerations were the focus of a regional workshop on IFE in Bali held in 2008 involving 16 country teams (each with local NGO and government representation). Teams were tasked with having to come up with country actions plans. Top of the 'to do' list was strengthening national policy guidance that reflected the provisions of the Operational Guidance on IFE and the Code. Follow up with country's eight months later found 10 out of 11 countries had moved on this action point1. A similar model could be applied in the Gaza context.

A conclusion we draw from the Gaza articles is that we need to see how to contextualise our expectations of standards in emergencies and how to help both those working long-term in chronic situations and those responding to acuteon- chronic emergencies achieve best practice.

A final point with respect to these two articles is that Gaza represents a prime example of the artificial distinction often made between emergency and non-emergency contexts. The most recent conflict only exacerbated the existing poor living conditions. Many of the challenges and recommendations that emerged from the Save the Children assessment were aimed at addressing chronic issues. Yet, the spotlight of international media attention on Gaza soon dimmed once the Israeli bombardment was over, leaving the population to once again endure the less sensational chronic deprivation to which it had habituated. At the ENN we wonder whether some of those journalists tripping over each other to sensationalise the Haiti emergency could be redeployed to other parts of the world, where chronic and largely silent emergencies continue and are underfunded.

Finally, we would like to express our appreciation of NECCCRW's submission of an article to Field Exchange, supported by DanChurchAid. The pages of Field Exchange are dominated to a large extent by international agency perspectives. The NECCCRW contribution has raised issues and questions that are slightly out of our 'comfort zone' while being consistent with a true 'field exchange'. We encourage more contributions to 'rock the boat'.

Jeremy Shoham, Editor
Marie McGrath, Sub-editor

Any contributions, ideas or topics for future issues of Field Exchange? Contact the editorial team on email: office@ennonline.net